Salud Mental

Cost-effectiveness analysis of interventions to achieve universal health coverage for schizophrenia in Mexico


Héctor Cabello-Rangel
Lina Díaz-Castro
Carlos Pineda-Antúnez


Introduction. To achieve universal coverage in mental health, it is necessary to demonstrate which interventions should be adopted.

Objective. Analyze the alternatives of pharmacological and psychosocial treatment in Mexico for patients diagnosed with schizophrenia, as well as Early Intervention in Psychosis Program.

Method. The Extended cost effectiveness analysis (ECEA), it is implemented under scenario the option of treatment in Mexico, which includes: typical or atypical antipsychotic medication plus psychosocial treatment, assuming that all the medications will be provided to the patient, a measure of effectiveness is the years of life adjusted to disability (DALYs).

Results. The effect of Universal Public Financing (UPF) is reflected in avoiding 147 DALYs for every 1,000,000 habitants. In addition, has a positive effect in the avoided pocket expenditures from US $ 101,221 to US $ 787,498 according to the type of intervention. Increasing government spending has a greater impact on the poorest quintile, as a distributive effect of the budget is generated. Respect to the value of insurance, the quintile III is the one who is most willing to pay for having insurance, on the other hand, in the highest income quintile, the minimum assurance valuation was observed.

Discussion and conclusion. The reduction in out-of-pocket spending is uniform across all quintiles; “Early Intervention in Psychosis Program” is not viable for middle income countries, as México. The ECEA is a convenient method to assess the feasibility and affordability of mental health interventions to generate information for decision makers.
Universal health coverage, schizophrenia, cost-effectiveness


Download data is not yet available.


Brigham, E. F., & Houston, J. F. (2005). Fundamentals of financial management (10th Edition). Ed Thomson.

Cabello-Rangel, H., Díaz-Castro, L., & Arredondo, A. (2011). Costo-efectividad de intervenciones para esquizofrenia en México. Salud Mental, 34(2), 95-102.

Chatterjee, S., Naik, S., John, S., Dabholkar, H., Balaji, M., Koschorke, M., ... Thornicroft, G. (2014). Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): A randomized controlled trail. The Lancet, 383(9926), 1385-1394. doi: 10.1016/S0140-6736(13)62629-X

Chisholm, D. (2005). Choosing cost-effective interventions in psychiatry: Results from the CHOICE programme of the World Health Organization. World Psychiatry, 4(1), 37-44.

Chisholm, D., & Saxena, S. (2012). Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. British Medical Journal, 344, e609. doi: 10.1136/bmj.e609

Institute for Health Metrics. (2010). Global Burned Diseases. Retrieved from

Instituto Mexicano del Seguro Social. (2017). Documentación compra consolidada 2016-2017. Retrieved from

Kohn, R., Levav, I., Caldas de Almeida, J. M., Vicente, B., Silveira Guerra Andrade, L. H., Caraveo-Anduaga, J. J., Saxena, S., & Saraceno, B. (2005). Mental disorders in Latin America and the Caribbean: a public health priority. Revista Panamericana de Salud Pública, 18(4-5), 229-240. doi: 10.1590/s1020-49892005000900002

Lara-Muñoz, M. C., Robles-García, R., Orozco, R., Saltijeral Méndez, M. T., Medina-Mora, M. E., & Chisholm, D. (2010). Estudio de costo-efectividad del tratamiento de la esquizofrenia en México. Salud Mental, 33(3), 211-218.

Leucht, S., Pitschel-Walz, G., Abraham, D., & Kissling, W. (1999). Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophrenia Research, 35(1), 51-68. doi: 10.1016/s0920-9964(98)00105-4

Lora, A., Kohn, R., Levav, I., McBain, R., Morris, J., & Saxena, S. (2012). Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low- and middle-income countries. Bulletin of the World Health Organization, 90, 47-54B. doi: 10.2471/BLT.11.089284

McCrone, P., Knapp, M., & Dhanasiri, S. (2009). Economic impact of services for first-episode psychosis: A decision model approach. Early Intervention in Psychiatry, 3(4), 266-273. doi: 10.1111/j.1751-7893.2009.00145.x

Patel, V. (2016). Universal health coverage for schizophrenia: A global mental health priority. Schizophrenia Bulletin, 42(4), 885-890. doi: 10.1093/schbul/sbv107

Raykar, N., Nigam, A., & Chisholm, D. (2015). An extended cost-effectiveness analysis of schizophrenia treatment in India under universal public finance. Cost Effectiveness and Resource Allocation, 14(1), 9. doi: 10.1186/s12962-016-0058-z

Secretaria de Salud. (2005). Sistema de Protección Social en Salud. Elementos conceptuales, financieros y operativos. México, D. F. ISBN 970-721-290-X. Retrieved from

Solmi, F., Mohammadi, A., Perez, J. A., Hameed, Y., Jones, P. B., & Kirkbride, J. B. (2018). Predictors of disengagement from Early Intervention in Psychosis services. The British Journal of Psychiatry, 213(2), 477-483. doi: 10.1192/bjp.2018.91

Thieda, P., Beard, S., Richter, A., & Kane, J. (2003). An economic review of compliance with medication therapy in treatment of schizophrenia. Psychiatric Services, 54(4), 508-516. doi: 10.1176/

Union Nations Organization. (2012). Sustainable Development Goals 2030. Genève Switzerland.

Verguet, S., Laxminarayan, R., & Jamison, D. T. (2015). Universal public finance of tuberculosis treatment in India: An extended cost-effectiveness analysis. Health Economics, 24(3), 318-332. doi: 10.1002/hec.3019

Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., ... Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1575-1586. doi: 10.1016/S0140-6736(13)61611-6

Wirtz, V. J., Santa-Ana-Tellez, Y., Servan-Mori, E., & Avila-Burgos, L. (2012). Heterogeneous effects of health insurance on out-of-pocket expenditure on medicines in Mexico. Value in Health, 15(5), 593-603. doi: 10.1016/j.jval.2012.01.006

World Bank. (s.f.). Indicadores del desarrollo mundial [Conjunto de datos]. Access date: July 2018. Retrieved from

World Health Organization (2013). Investing in mental health: evidence for action. Geneva, Switzerland.